CARE HOME ADULTS 18-65
Holt Mill House Lloyd Street Whitworth, Rochdale Lancashire OL12 8AA Lead Inspector
Christine Mulcahy Unannounced 04 July 2005 14:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Holt Mill House Address Lloyd Street Whitworth Rochdale Lancashire OL12 8AA 0161 7648530 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Anna Geraldine Ellis Mr Patrick Copple Care Home Only Personal Care (PC) 3 Category(ies) of Learning disability (LD) 3 registration, with number of places Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The addition number approved (1) is only valid for named specified service user. 2 The service should at all time employ a suitably qualified manager who is registered by CSCI. Date of last inspection 24 September 2004 Brief Description of the Service: Holt Mill House is registered with the Commission for Social care Inspection to provide personal care and accommodation to three younger adults who have a learning disability. Holt Mill House is situated close to the town centre of Whitworth near Rochdale and is within walking distance of local amenities including shops, post office, bus stop and community health services. Holt Mill House is attached to a day service resource centre that provides day care for adults with a learning disability. The resource centre is used by two of the three Holt Mill House service users. Holt Mill House is a terraced property that provides facilities and care in a homely environment. The ground floor of the home consists of a dining kitchen, utility room, a spacious lounge dining area and a W.C. In addition, there is an office area, which is also used to store medication and records safely. The first floor is accessed by a staircase and provides three large single bedrooms one of which is en suite. Other bedrooms are adjacent to a separate bathroom. Furnishings and is domestic in character. There is an enclosed garden to the rear of the property. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The summary below is an overview of the findings of an unannounced inspection conducted at Holt Mill House on Monday 4th July 2005. The service was inspected against the National Minimum Standards for Adults (18 – 65). Holt Mill House is registered to provide care and accommodation to 3 younger adults with learning disabilities. The service users at Holt Mill House sometimes display challenging behaviour therefore the home is staffed to meet the needs of the service users. At the time of the inspection 2 service users were accommodated at the home. Because of the degree of both service users disability, it was not possible for the inspector to verbally communicate or have meaningful contact with either. Therefore much of this report is written from discussion with the registered manager and observations made at the home. Records relating to the two service users were inspected, along with the rooms they occupy in the home. Observations of the care provided were made and records were examined. This is called ‘Case tracking’. Case tracking is also used as an inspection tool with regard to staff working in the home. In this instance records relating to staff were not available at the time of the inspection. This inspection involved discussion with the registered manager, observations of the care staff as they carried out their duties and notes, discussions with staff and observations, taken from a previous introductory visit made to Holt Mill House on Friday 17th June 2005. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
Control and restraint policies and procedure had been updated and reviewed to provide a safer working environment for staff and a safer living environment for service users. The services control and restraint policy and procedure was robust and clarified the actions staff may take to avoid the use of restraint. Most of the time staff were able to use diverting and diffusing skills along with their own personal knowledge of the service user and their needs so as to maintain a safe environment. The appointment of a new service manager has highlighted some service deficiencies that are now being addressed and steps to improve areas of the service are underway. Steps to ensure that one service user is better supported and needs are better met are being introduced by the management team.
Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 7 Staff shifts are now shorter and there is the flexibility to swap shifts with colleagues enabling a better skill mix of staff. Staff sleep-in duties have now been reduced to one sleep in per week and there is a greater opportunity for staff from the other satellite houses within the scheme to experience work at Holt Mill House. These improvements have been a positive move forward for both staff and service users at the home. New experienced staff have been recruited specifically to meet the culturally diverse needs of service users. And there is a greater opportunity for staff to work in liaison with service user relatives more frequently. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 2 Service users admissions had been based on a full assessment. The home had developed with each service user an individual plan of care based on the assessment. EVIDENCE: A service user personal file was examined and contained a copy of the care management assessment. One file contained written evidence of past and present holistic assessments that included all service user needs as far as possible. Assessments and management of risk, physical and mental health care, specific condition related needs, specialist input and methods of communication were all sections that made up a comprehensive plan of care. Any potential restrictions on choice, freedom, services or facilities had been agreed with the service user relatives and representatives before admission. It was apparent that movement and liberty restrictions in place were legally and ethically bound and ensured the service user and existing service users received the care and support identified during the assessment stage. Robust risk assessments and detailed care plans highlighted the need for some practices to be in place to protect the existing service users from risk of harm. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 6, 9 All service users had an individual care plan. Some risk management strategies were agreed and recorded in service users plans. Service users plans of care were reviewed regularly. EVIDENCE: Service user care plans were comprehensive and gave clear instructions on how the care should be delivered. Each care plan included a service user personal profile and addressed areas of care such as routines, likes and dislikes, allergies, health needs, personal hygiene and general health. Care plans were presented in a style and format appropriate to the needs of service users. Plain English, bold print, photographs and pictures were used where necessary. Care plan outcomes were measured against the care management assessment, case reviews and risk assessments to ensure that as far as possible service users reached their potential. Care plans were reviewed regularly with relatives and relevant professionals, and signed and dated by staff. Written evidence confirmed that appropriate relatives and professionals had been consulted to ensure that staff enabled service users to take responsible
Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 11 risks. Action to minimise identified risks and hazards were clearly recorded and reviewed frequently. Case tracking confirmed that a service users care plan contained risk assessments for a number of activities where potential risks were apparent. The care plan also included a number of day-to-day activities like, waking up in the morning and a drive in the homes vehicle, the physical risks surrounding this and how the staff team should manage these risks. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 14 Service users were involved in leisure activities that were appropriate to them EVIDENCE: Case tracking and discussion with the registered manager confirmed that one service user was encouraged to attend a resource centre attached to the home. The service user had the opportunity to meet people, make friends and take part in meaningful activities. When asked the registered manager said that service users were supported to become part of the local community where possible and were involved in a range of leisure activities like walking and visits to the cinema. The responsible individual had provided a vehicle for the sole use of the service users and this was used frequently by them. Risk assessments relating to the risks involved in some of these activities had been carried out. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 18,19 Service user health care needs were well managed by staff and other appropriate professionals EVIDENCE: Due to complex needs one service user required physical intervention and support from two members of staff at all times. The inspector discreetly observed staff using specialised techniques with the service user to prevent them from harm or injury as they went about their day-to-day activities. These techniques were also used to prevent staff from using restraint. Risk assessments in the use of restraint techniques when dealing with challenging situations from service users were available at the home. They gave clear advice to staff on the alternative methods that could be used to support the service user in such situations. The document made clear what the staff should do when other measures had failed to produce a safe outcome. Service users were registered with a G.P and received regular dental, optician and other social and health care support. Case tracking confirmed that input from other outside professionals was a necessary part of the care planning process. Detailed records of changes in service user behaviour were kept up to date and staff were strongly encouraged to contribute to these records. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 14 From care plans examined it was evident that staff observations and contact with other professionals was relevant. This information was recorded to ensure service users interactions and lifestyle was reflected accurately. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 22, 23 None of these standards were assessed at this inspection EVIDENCE: Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 24, 30 Facilities in the home met the criteria for its stated purpose. Most areas in the home were safe and well maintained. The home was clean, pleasant, and hygienic. EVIDENCE: The location of the home was suitable for it’s stated purpose. The home offered the use of a lounge area, kitchen and utility room. A tour of the home showed a good standard of cleanliness and hygiene. The inspector examined 2 bedrooms during the inspection. Both were personalised and close to the toilet and bathroom. The kitchen and dining room area were examined and seen to be clean and hygienic. Repair work was required on the internal and external gable end wall of the kitchen to prevent further deterioration. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 32, 33, 35 The level of staff training was difficult to determine as staff records were not available for inspection. EVIDENCE: The registered manager stated that staff at Holt Mill had received appropriate training to ensure that service users needs were fully met. Discreet observation confirmed that staff were able to use specialised diverting techniques to support a service user with complex needs. The registered manager discussed how training and development was linked to the homes service aims and showed the inspector recent training material on Autism. She described how the management team were working towards meeting all staff training needs on a service user and staff needs led basis. Evidence to confirm this would normally be found on staff personal files, but these were not available at the time of the inspection. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA37, 40, 42 Some policies and procedures that relate to safe working practices were available at the home. Other policies and procedures need reviewing to ensure that service users are protected from risk of harm. EVIDENCE: Discussion with the registered manager highlighted that regular maintenance checks had been carried out to ensure safety of the building and any findings had been recorded. Safety procedures and risk assessments were well documented and recorded and were available to staff to ensure safe working practices. Systems were in place to ensure that challenging situations involving service users and staff were risk assessed to ensure both were safe from harm. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 19 The registered manager showed the inspector copies of newly reviewed policies and procedures and discussed plans for these to be periodically updated and reviewed. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 x x x Standard No 31 32 33 34 35 36 Score x 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Holt Mill House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x 2 x 3 x F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 34 Regulation Schedule 4 (6) Requirement Timescale for action Immediate 2. YA 24 The registered manager must ensure that a record of all persons employed at the care home is kept at the home for protection of the service users and efficient running of the home. Regulation The registered manager must 23 ensure that the premises are kept in a good state of repair externally and internally. Please forward a copy of the homes maintenance and renewal programme which includes timescale and details as to when it is intended repairs to the kitchen wall will be complete. Monday 15th August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA 18 Good Practice Recommendations To complement the good practice already in place the registered manager should ensure that strategies to ensure the complex needs of one service user does not overshadow the needs of other service users living at Holt
F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 22 Holt Mill House 2. OP 42 Mill are in place. Regular discussions and with the service user and staff at the resource centre should be detailed and documented in the service user records to ensure an equal and consistent approach to meet the sevice user needs. Policies and procedures at the home are updated and reviewed periodically to ensure safe working practices. Holt Mill House F57 F07 S39980 Holt Mill House V231807 280605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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